Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a solitary unresectable liver metastasis?
Excellent question! Before starting any systemic treatments, has the patient undergone an MRI? Conducting an MRI prior to systemic therapy is crucial for accurately determining whether there are single or multiple liver metastases. The CAMINO study has shown that incorporating an MRI at the initial ...
Would you offer post operative radiation for a patient who had findings of lymphovascular invasion on salvage resection of a recurrent obturator node after definitive chemoradiation for cervical cancer?
If no gross disease and has had previous RT, I would favor no additional RT.
How do you consider SBRT relative to other emerging therapies for pediatric sarcomas, such as proton therapy or immunotherapy, in terms of efficacy and safety?
Treatment paradigms for pediatric malignancies have evolved through group trials over the past 5 decades, both in the US (e.g., COG) and abroad (SIOP). Sequential improvements have been made over the years to the quality of radiation for both pediatric and young adults, a population at risk for majo...
What factors would prompt you to offer post-operative RT in early-stage (T1-2N0) nasal cavity squamous cell carcinoma?
Margins less than 5 mm or piecemeal excision. PNI
Would you treat a prostate cancer patient with a positive peri-aortic node?
Such patients are good candidates for treatment. Patients with non-regional LNs (M1a) were included on STAMPEDE. In the M1a subgroup analysis presented at ESMO 2019, there was a significant improvement in FFS (HR 0.64, 0.43-0.96) and a trend to improvement in OS (HR 0.62, 0.35-1.09) (~180 patients i...
Is APBI appropriate in post menopausal women with small, triple negative breast cancers excised with negative margins?
We do have data to suggest that these patients do poorly with mastectomy alone vs other t1/t2 patients: Wang et al., PMID 21852010 Abdulkarim et al., PMID 21670451 Extrapolating from that, biologically, these seem to be more aggressive both locoregionally (despite mastectomy/removal of all breast ti...
Would you favor PCI or CABG for younger patients with radiation-associated cardiac disease in the absence of any significant valvular abnormalities?
Despite the fact that the common and most serious radiation-induced coronary stenosis (RICS) are ostial lesions of the left main and ostial RCA, we heavily favor PCI when feasible due to fibrotic mediastinal changes causing significant technical challenges during CABG. Restenosis is another challeng...
In which scenarios do you stage breast cancer using CT and nuclear bone scans versus PET-CT?
In a recent study (Dayes et al., PMID 37235845), systemic staging with FDG PET-CT more frequently changed the clinical stage from IIB or III breast cancer to stage IV disease (23% metastases detection rate) than staging with CTs of the chest, abdomen, pelvis, and a bone scan combined (11% metastases...
How would you treat a limited stage small cell carcinoma of the larynx?
70 Gy/35 fractions or equivalent with altered fractionation and small cell chemo with Elective nodal RT. I’ve only treated a few and have not cured one due to distant mets.
How do you manage stage III resectable NSCLC patients treated with neoadjuvant chemoimmunotherapy per CheckMate 816 with residual disease who subsequently refuse surgery?
(1) Carefully analyze what happened with the patient, their medical oncologist, and thoracic surgeon, (2) restage the patient with an FDG-PET/CT and brain MRI to rule out distant metastatic progression, (3) confirm with their medical oncologist that CRT-> Durva is still an option, (4) confirm that a...